Psychological adjustment and levels of self esteem in children with visual-motor integration difficulties influences the results of a randomized intervention trial

This study evaluates how much the effects of intervention programs are influenced by pre-existing psychological adjustment and self-esteem levels in kindergarten and first grade children with poor visual-motor integration skills, from low socioeconomic backgrounds. One hundred and sixteen mainstream kindergarten and first-grade children, from low socioeconomic backgrounds, scoring below the 25th percentile on a measure of visual-motor integration (VMI) were recruited and randomly divided into two parallel intervention groups. One intervention group received directive visual-motor intervention (DVMI), while the second intervention group received a non-directive supportive intervention (NDSI). Tests were administered to evaluate visual-motor integration skills outcome. Children with higher baseline measures of psychological adjustment and self-esteem responded better in NDSI while children with lower baseline performance on psychological adjustment and self-esteem responded better in DVMI. This study suggests that children from low socioeconomic backgrounds with low VMI performance scores will benefit more from intervention programs if clinicians choose the type of intervention according to baseline psychological adjustment and self-esteem measures.     

Psychological adjustment and levels of self esteem in children with visual-motor integration difficulties influences the results of a randomized intervention trial

This study evaluates how much the effects of intervention programs are influenced by pre-existing psychological adjustment and self-esteem levels in kindergarten and first grade children with poor visual-motor integration skills, from low socioeconomic backgrounds. One hundred and sixteen mainstream kindergarten and first-grade children, from low socioeconomic backgrounds, scoring below the 25th percentile on a measure of visual-motor integration (VMI) were recruited and randomly divided into two parallel intervention groups. One intervention group received directive visual-motor intervention (DVMI), while the second intervention group received a non-directive supportive intervention (NDSI). Tests were administered to evaluate visual-motor integration skills outcome. Children with higher baseline measures of psychological adjustment and self-esteem responded better in NDSI while children with lower baseline performance on psychological adjustment and self-esteem responded better in DVMI. This study suggests that children from low socioeconomic backgrounds with low VMI performance scores will benefit more from intervention programs if clinicians choose the type of intervention according to baseline psychological adjustment and self-esteem measures.     

A comparison of intensive behavior analytic and eclectic treatments for young children with autism

We compared the effects of three treatment approaches on preschool-age children with autism spectrum disorders. Twenty-nine children received intensive behavior analytic intervention (IBT; 1:1 adult:child ratio, 25-40 h per week). A comparison group (n=16) received intensive "eclectic" intervention (a combination of methods, 1:1 or 1:2 ratio, 30 h per week) in public special education classrooms (designated the AP group). A second comparison group (GP) comprised 16 children in non-intensive public early intervention programs (a combination of methods, small groups, 15 h per week). Independent examiners administered standardized tests of cognitive, language, and adaptive skills to children in all three groups at intake and about 14 months after treatment began. The groups were similar on key variables at intake. At follow-up, the IBT group had higher mean standard scores in all skill domains than the AP and GP groups. The differences were statistically significant for all domains except motor skills. There were no statistically significant differences between the mean scores of the AP and GP groups. Learning rates at follow-up were also substantially higher for children in the IBT group than for either of the other two groups. These findings are consistent with other research showing that IBT is considerably more efficacious than "eclectic" intervention.     

The effect of a computerized visual perception and visual-motor integration training program on improving Chinese handwriting of children with handwriting difficulties

This study aimed to investigate the effect of a computerized visual perception and visual-motor integration training program to enhance Chinese handwriting performance among children with learning difficulties, particularly those with handwriting problems. Participants were 26 primary-one children who were assessed by educational psychologists and occupational therapists to have handwriting difficulties. They were matched according to their age and then randomly assigned into either the control group or the experimental group. Subjects in the experimental group (n = 13) would receive eight sessions of computerized visual perception and visual-motor integration training together with a home training program while those in the control group (n = 13) would only receive conventional handwriting training by teachers, which focused mainly on remedial handwriting exercises. Results from repeated measure ANOVA revealed that children in the experimental group showed improvements in their visual perception skills as well as in their handwriting time. Both the “On Paper” time and “In Air” time of this group were improved when compared to the control group. However, no significant differences were found in visual-motor integration skill and handwriting legibility between the two groups after the intervention. This computerized training program focusing on visual perception and visual-motor integration training appeared to be effective in enhancing the handwriting time among children with handwriting difficulties. However, the training program did not seem to improve the legibility of children.     

Neurodevelopmental outcome in children with posthemorrhagic hydrocephalus

To determine the factors affecting the neurodevelopmental outcome in children with posthemorrhagic hydrocephalus, 78 children with intraventricular hemorrhage grade 3 or 4 were analyzed concerning the outcome in relation to the grade of intraventricular hemorrhage and intervention (surgical, medical, or no intervention) by means of a follow-up study. The mean age of the subjects at the last follow-up was 9.8 years. In children with intraventricular hemorrhage grade 4 with parenchymal hemorrhage, the outcomes in the group not requiring intervention were better than those in the groups requiring intervention, whereas in children with intraventricular hemorrhage grade 3 without parenchymal hemorrhage, there were no differences in the outcomes among the three groups with and without intervention. For the subjects who had undergone the same intervention, the outcomes in children with intraventricular hemorrhage grade 4 were worse than those in children with intraventricular hemorrhage grade 3. The outcomes in the children with surgical intervention only correlated with the grade of intraventricular hemorrhage. From these findings, we concluded that the outcomes in children with posthemorrhagic hydrocephalus were far more affected by the existence or extent of parenchymal hemorrhage than by the hydrocephalic process, which was suggested to be effectively controlled by the intervention.     

Comparison of behavior analytic and eclectic early interventions for young children with autism after three years

In a previous study, we compared the effects of just over one year of intensive behavior analytic intervention (IBT) provided to 29 young children diagnosed with autism with two eclectic (i.e., mixed-method) interventions (Howard, Sparkman, Cohen, Green, & Stanislaw, 2005). One eclectic intervention (autism programming; AP) was designed specifically for children with autism and was intensive in that it was delivered for an average of 25–30 h per week (n = 16). The other eclectic intervention (generic programming; GP) was delivered to 16 children with a variety of diagnoses and needs for an average of 15–17 h per week. This paper reports outcomes for children in all three groups after two additional years of intervention. With few exceptions, the benefits of IBT documented in our first study were sustained throughout Years 2 and 3. At their final assessment, children who received IBT were more than twice as likely to score in the normal range on measures of cognitive, language, and adaptive functioning than were children who received either form of eclectic intervention. Significantly more children in the IBT group than in the other two groups had IQ, language, and adaptive behavior test scores that increased by at least one standard deviation from intake to final assessment. Although the largest improvements for children in the IBT group generally occurred during Year 1, many children in that group whose scores were below the normal range after the first year of intervention attained scores in the normal range of functioning with one or two years of additional intervention. In contrast, children in the two eclectic treatment groups were unlikely to attain scores in the normal range after the first year of intervention, and many of those who had scores in the normal range in the first year fell out of the normal range in subsequent years. There were no consistent differences in outcomes at Years 2 and 3 between the two groups who received eclectic interventions. These results provide further evidence that intensive behavior analytic intervention delivered at an early age is more likely to produce substantial improvements in young children with autism than common eclectic interventions, even when the latter are intensive.     

Etiological differences in patterns of psycholinguistic development of children of IQ 30 to 60.

We compared the psycholinguistic abilities of 131 mentally retarded children (IQs 30 to 60) of different etiological classifications (Down's syndrome, biologically brain damaged, environmentally caused retardation, unknown cause) and characterized each etiology according to the different patterns of psycholinguistic skills exhibited by the children. Level of skills was determined by the Illinois Test of Psycholinguistic Abilities, which was administered to each subject. Down's syndrome children exhibited significantly lower verbal-auditory skills than visual-motor skills. The environmentally caused retardation group showed no significant differences in development of psycholinguistic channels. Down's syndrome children had significantly lower verbal-auditory abilities than did the other etiological groups of severely retarded children. Etiological differences in the visual-motor channel were less marked.     

Clinical significance of neuropsychological improvement after supplementation with omega-3 in 8–12 years old malnourished Mexican children: A randomized,double-blind,placebo and treatment clinical trial

It has been shown that supplementation with omega-3 improves cognitive performance, especially in infants and toddlers, but it is unknown whether these results are effective in older malnourished children. The aims of this study, therefore, were to investigate the omega-3 supplementation effects in 8- to 12-year-old children and to know which neuropsychological functions improve after three months of intervention in a sample of Mexican children with mild to moderate malnutrition. This study was a randomized, double-blind, treatment and placebo study of 59 children aged 8–12 years who were individually allocated to 2 groups. The duration of the intervention lasted 3 months. Neuropsychological performance was measured at baseline and at 3 months. Results show that more than 50% of children in the treatment group had greater improvement in 11 of the 18 neuropsychological variables studied. Processing speed, visual-motor coordination, perceptual integration, attention and executive function showed improvement in more than 70% of the omega-3 supplemented children. This trial was registered at clinicaltrials.gov as NCT01199120.     

The TAFES multi-family group intervention for Kosovar refugees: a feasibility study

The object of this study was to describe a feasibility study of the Tea and Families Education and Support (TAFES) intervention used in a group of newly resettled adult refugees from Kosova. The subjects were 86 newly resettled Kosovar refugees in Chicago who gave informed consent to participate in an investigation of the TAFES intervention. All subjects received family home visits, and most participated in the TAFES multi-family groups. The instruments were administered to adult participants before and 3 months after the intervention. The TAFES program had contact with 61 Kosovar refugee families, of which 42 families (69%) engaged in TAFES groups, including families with educated and working members. Several characteristics were associated with engaging in TAFES groups and included lower monthly family income and higher age of the first child. The uncontrolled postintervention assessments demonstrated increases in social support and psychiatric service use associated with engagement in the TAFES group. Participants also showed time changes in scale scores assessing trauma mental health knowledge, trauma mental health attitudes, and family hardiness. This study provides preliminary evidence that multi-family support and education groups are a feasible and possibly beneficial intervention for newly resettled refugees and indicates the need for further studies.     

The River Street Autism Program: a case study of a regional service center behavioral intervention program

An urgent demand from Connecticut parents for behavioral intervention resulted in the development of the River Street Autism Program (RSAP). This research-to-practice program implements intervention service based on empirical research findings conducted with children diagnosed with autism and pervasive developmental disorders. RSAP is provided through a regional service center and provides services for children entering the program at 2 to 5 years old. Because of the diverse nature of the districts served by RSAP, the delivered services varied according to the needs of the districts, available funding, and family preferences. Program evaluation data were therefore examined with regard to outcomes for children who received programs with differing numbers of treatment components. Treatment components that varied across children were treatment intensity, duration, extent of family participation, staff training, and supervision. Outcome data revealed that families reported greater gains in child functioning and quality of life when children received programs with more treatment components.     

Functional decline in children undergoing selective dorsal rhizotomy after age 10

Aim To compare function and gait in a group of children older than most children who received selective dorsal rhizotomy (SDR) with age‐ and function‐matched peers who received either orthopedic surgery or no surgical intervention. Method A retrospective study examined ambulatory children with diplegic cerebral palsy, aged between 10 years and 20 years and categorized in Gross Motor Function Classification System (GMFCS) levels I or II. Three groups were considered: (1) children who had selective dorsal rhizotomy (n=8; two females, six males; mean age 15y 4mo at SDR, 16y 8mo at follow‐up); (2) children who had orthopedic surgery (n=9; three females, six males; mean age 14y 6mo at SDR, 15y 1mo at follow‐up), and (3) children who had no surgical intervention (n=9; two females, seven males; mean age 15y 6mo at follow‐up). Longitudinal measures of gait analysis (velocity, gait deviation index, and gait variable scores) and gross motor function (GMFCS level, Gross Motor Function Measure scores, and centiles) were examined. Results No significant differences were found between changes in gait comparing rhizotomy with orthopedic surgery; however, the group who received orthopedic surgery demonstrated improved gait compared with the group without surgical intervention. Longitudinal comparisons of gross motor function demonstrated a decrease in the group who received SDR. Between‐group analysis of outcomes also demonstrated worse outcomes of the SDR group compared with the orthopedic surgery group and with the no surgical intervention group. Interpretation Rhizotomy in older children was associated with functional declines compared with similar children who had no surgery and with those who underwent orthopedic surgery. This suggests that age greater than 10 years might be a contraindication for SDR if the goal is to improve motor skills.     

Service provision and functional independence in depressed stroke patients and the effect of social work intervention on these.

OBJECTIVE To compare the provision of health and social services between a social work intervention and non-intervention group. DESIGN Depressed stroke patients were randomly assigned to either an intervention or non-intervention group. Over a 4 month period both groups were visited three times by an independent assessor who rated them on service provision and functional independence. SETTING Patients' homes. PATIENTS 44 depressed stroke patients. INTERVENTION Both groups were given an information booklet and the intervention group were then visited regularly by a research social worker over a period of 4 months. The social worker adopted a pragmatic approach which included providing counselling and information on services and benefits. MAIN RESULTS The study groups did not differ in level of social independence (p greater than 0.05) or total number of financial benefits (p greater than 0.05), services (p greater than 0.05) or aids (p greater than 0.05) received either before or after intervention. When the results from the two groups were combined, home help and meals-on-wheels were the most frequently provided services (25% of patients). Walking aids (72% of patients) and bath aids (59% of patients) were the most frequently provided aids to daily living. CONCLUSION Social work assistance had little effect on service provision or level of functional independence.     

Examining the Efficacy of a Family Peer Advocate Model for Black and Hispanic Caregivers of Children with Autism Spectrum Disorder

Autism spectrum disorder (ASD) affects individuals across all racial and ethnic groups, yet rates of diagnosis are disproportionately higher for Black and Hispanic children. Caregivers of children with ASD experience significant stressors, which have been associated with parental strain, inadequate utilization of mental health services and lower quality of life. The family peer advocate (FPA) model has been utilized across service delivery systems to provide family-to-family support, facilitate engagement, and increase access to care. This study used a randomized controlled design to examine the efficacy of FPAs in a racially and ethnically diverse sample. Results demonstrate significantly increased knowledge of ASD and reduced levels of stress for caregivers who received the FPA intervention as compared to treatment as usual.     

Needs-based cognitive-behavioural family intervention for carers of patients suffering from schizophrenia: 12-month follow-up.

OBJECTIVE: To examine longer-term effectiveness of a needs-based family intervention for carers and out-patients suffering from schizophrenia. METHOD: Seventy-nine unselected patient-carer pairs were recruited from a geographical area and allocated randomly to one of two conditions. One group received needs-based cognitive-behavioural family intervention in combination with general family support plus the standard care. The control group received the general family support and standard care only. RESULTS: Analysis was carried out on an intention-to-treat basis. There was a significant advantage for family intervention, in terms of relapse (37% relapsed compared to 72%, NNT=3) and on other clinical measures. Treatment group and medication compliance were significant and independent predictors of relapse. There was a significant reduction in carer needs in the intervention group. CONCLUSION: Family intervention directed at carers' needs within a standard mental health service can produce benefits for patients beyond the term of intervention.     

The Little Hulton Project: A Pilot Child Clinical Psychology Service for Pre-School Children and their Families

A community-based early intervention psychology service for pre-school children with emotional and behavioural problems is described. The intervention included parent training groups, a weekly open clinic, and multi-agency training, liaison and consultancy. The aims were to provide successful intervention to families, to maximise liaison with community staff and to provide a seamless service to and from the main hospital department. Evidence indicated improvements in parental coping and children's behavioural difficulties using standardised measures and gains were maintained at 6- and 12-month follow-up. This article outlines a framework for service delivery in a small community with high socio-economic deprivation.     

Integrating Cognitive-Behavioral Psychotherapy for Persons with Schizophrenia into a Psychiatric Rehabilitation Program: Results of a Three Year Trial

Emerging models of cognitive-behavioral treatment (CBT) offer promising new intervention strategies in the psychotherapy of schizophrenia. These models, however, have not been integrated into community support programs and evaluated in comparison to standard community treatments. This study examined differences in outcomes of clients who received long-term day treatment program services (DTP) compared to clients who received individual CBT that was included as part of their DTP treatment. Twenty-four clients were randomly assigned to DTP treatment or CBT/DTP treatment. Data on standardized measures of psychosocial functioning, symptomatology and rehospitalizations were collected over the course of three years of treatment. Analysis of variance with repeated measures was conducted to evaluate the effects of type of treatment (CBT/DTP and DTP) and time (dependent variable scores taken at the end of treatment years one, two and three) on the three outcome variables. Results indicate significant improvement for the CBT/DTP group compared to the DTP group in the patterns of change over time for psychosocial functioning and symptomology. In addition to this significant group/time interaction the time factor was also significant for both variables. For rehospitalizations the time factor was significant and the group/time factor was nonsignificant. Implications for service delivery to persons with schizophrenia and suggestions for future research are discussed.     

Cognitive and motor abilities in preschool hydrocephalics

The neuropsychological performance of three groups of preschool children was evaluated: (a) one with hydrocephalus associated with myelomeningocele; (b) one with hydrocephalus associated with intraventricular hemorrhage and very low birth weight; and (c) a nonhydrocephalic normal comparison group. Multivariate profile analysis revealed lower levels of performance on measures of verbal and nonverbal cognitive skills for both groups of hydrocephalic children relative to normals. Comparison of group profiles on tasks requiring figure copying as opposed to figure matching and analysis of specific gross and fine motor skills revealed that both hydrocephalic groups had impaired visual-motor integration in the presence of average visual perceptual matching. In addition, different patterns of motor skill deficits were found for each hydrocephalic group. The results of this study suggest that decreased visual-motor integration and etiology-specific motor deficits are major sequelae of these forms of hydrocephalus in the preschool years.     

Interventions for reducing missed initial appointments at a community mental health center

The present study attempted to reduce the initial appointment no-show rates at a CMHC through the use of several intervention techniques. One hundred-fifty individuals who called for an intake appointment were randomly assigned to either a control group or one of the following experimental groups: letter prompt received one day before appointment, letter prompt received three days before appointment, orientation letter received one day before appointment or orientation letter received three days before appointment. Individuals assigned to the one day orientation group had significantly lower no-show rates than individuals assigned to the control group (17% vs. 43%). The other groups were not significantly different from the control group. The effectiveness of the one day orientation letter for reducing no-show rates and its application at a CMHC was discussed.     

药物联合心理干预治疗儿童多动症患者疗效观察

目的:探讨药物联合心理干预对儿童多动症患者的疗效。方法:56例多动症患儿随机分为干预组(28例)和对照组(28例),对干预组予哌甲酯治疗外,实施6周心理干预(行为干预、家庭支持治疗及生物反馈);对照组仅予哌甲酯治疗。两组均于治疗开始及治疗6周实施Corners父母问卷测验。结果:治疗6周后,两组症状较治疗前均有改善,差异有统计学意义(P<0.01)。干预组较对照组品行问题、冲动多动问题、多动指数因子分进步更为明显(P<0.01)。结论:心理干预联合药物治疗比单独药物治疗可更好地改善多动症患儿的症状。     

A pilot randomized controlled clinical trial to improve antiepileptic drug adherence in young children with epilepsy

The primary aim was to examine the preliminary efficacy of a family tailored problem‐solving intervention to improve antiepileptic drug (AED) adherence in families of children with new‐onset epilepsy. Secondary aims were to assess changes in targeted mechanisms and treatment feasibility and acceptability. Fifty families (M_age = 7.6 ± 3.0; 80% Caucasian; 42% idiopathic localization related) completed baseline questionnaires and were given an electronic monitor to observe daily AED adherence. If adherence was ≤ 95% in the first 7 months of the study, families were randomized (Supporting Treatment Adherence Regimens (STAR): n = 11; Treatment as Usual (TAU): n = 12). Twenty‐one families were not randomized due to adherence being ≥95%. The STAR intervention included four face‐to‐face and two telephone problem‐solving sessions over 8 weeks. Significant group differences in adherence were found during active intervention (weeks 4–6; TAU = ?12.0 vs. STAR = 18.1, p < 0.01; and weeks session 6–8: TAU = ?9.7 vs. STAR = 15.3, p < 0.05). Children who received the STAR intervention exhibited improved adherence compared to children in the TAU group during active treatment. Significant changes in epilepsy knowledge and management were noted for the STAR group. Families expressed benefitting from the STAR intervention. Future studies should include a larger sample size and booster intervention sessions to maintain treatment effects over time.